In this episode of EMIGCAST, we’re going to switch gears.  We’ve created a clinical scenario with some questions for listeners at different levels of their training and we’re going to talk through the case. We plan on making these types of episodes part of our regular programming in the future. It should be fun.  Hope you enjoy it!  If you have time, take the 3 question quiz before listening to the episode.  There’s a link below and we’ve also posted the questions.

Quiz link: http://tinyurl.com/Aug2016Quiz

Clinical Scenario:

48 year old male with no significant past medical history presenting with acute right flank pain.  It started suddenly early this evening while he was eating dinner and has been increasing in intensity over the last several hours.  The pain is currently 10/10 in severity and radiates to his groin.  Nothing seems to relieve the pain or exacerbate it.  He has had some nausea and pink urine, but no fevers or vomiting.

Basic Science Question: MS1s and MS2s

The most common cause of this disease is formed from which substance?

  1. Bile
  2. Cholesterol
  3. Calcium
  4. Uric acid

Clerkship students: MS3s and MS4s

You order a CBC, CMP, Ptt/INR, and urinalysis.  It returns a small bump in creatinine and large blood on urinalysis.

What is the most sensitive and specific imaging modality to confirm the presence of the suspected pathology causing this disease?

  1. KUB X-ray
  2. Non-contrast helical CT
  3. Ultrasound
  4. Biopsy

Final discussion:

What is the next best order in the Emergency Department?

  1. Bedside ultrasound
  2. Non-contrast helical CT
  3. KUB X-ray
  4. Intravenous Pyelourethrography

Links to literature discussed

http://www.ncbi.nlm.nih.gov/pubmed/22685250

http://www.ncbi.nlm.nih.gov/pubmed/25229916

 

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